[Challenges of adolescents' adherence to therapy]. / Uitdagingen rond de therapietrouw van adolescenten.

Non-adherence occurs at any age, in all chronic diseases, and has a major impact on clinical outcomes. Non-adherence is primarily determined by perceptions of illness and medication beliefs. During puberty, adolescents attain independence from their parents and attach to their peers. This complicates successful self-management of chronic illness, because the adolescents avoid standing out from their peers. Discussion of barriers hindering successful self-management in adolescents can be promoted by seeing the patient alone, without the parents being present, and by acknowledging the patient's independence and responsibilities.

The impact of discussing exercise test results of young asthmatic children on adherence to maintenance medication.

OBJECTIVE: Parents' awareness of their child's asthma may improve by discussing an exercise challenge test (ECT) result with them. We investigated the influence of discussing an ECT result with parents on adherence to inhaled maintenance medication, parental illness perceptions and medication beliefs in young asthmatic children. METHODS: A total of 79 children, 4-7 years old and enrolled in our standard comprehensive asthma care program, performed an ECT to assess exercise induced bronchoconstriction (EIB). The result of the ECT was immediately discussed with the parents. Median medication adherence level was measured with electronic medication loggers from six weeks before the ECT till six weeks afterwards. Parental beliefs about medicines and illness perceptions were measured with the Beliefs about Medicines Questionnaire (BMQ) and the Brief Illness Perceptions Questionnaire (B-IPQ). RESULTS: The median baseline adherence level was high (83%) and showed a small significant decline after the ECT. There was no significant difference in the decrease in median adherence level between the children with or without EIB. Most parents (82.1%) showed a positive necessity-concern ratio at baseline, as measured with the BMQ. There was no clinical relevant change in medication concerns and necessity scores or in illness perceptions. CONCLUSION: Discussing ECT results with parents does not modify median adherence levels to inhaled maintenance medication nor medication beliefs of highly adherent young asthmatic children who are already enrolled in a comprehensive asthma care program.

Automated reminders decrease postoperative nausea and vomiting incidence in a general surgical population.

BACKGROUND: Guidelines to minimize the incidence of postoperative nausea and vomiting (PONV) have been implemented in many hospitals. In previous studies, we have demonstrated that guideline adherence is suboptimal and can be improved using decision support (DS). In this study, we investigate whether DS improves patient outcome through improving physician behaviour. METHODS: Medical information of surgical patients is routinely entered in our anaesthesia information management system (AIMS), which includes automated reminders for PONV management based on the simplified risk score by Apfel and colleagues. This study included consecutive adult patients undergoing general anaesthesia for elective non-cardiac surgery who were treated according to the normal clinical routine. The presence of PONV was recorded in the AIMS both during the recovery period and at 24 h. Two periods were studied: one without the use of DS (control period) and one with the use of DS (support period). DS consisted of reminders on PONV both in the preoperative screening clinic and at the time of anaesthesia. RESULTS: In the control period, 981 patients, of whom 378 (29%) were high-risk patients, received general anaesthesia. Overall, 264 (27%) patients experienced PONV within 24 h. In the support period, 1681 patients, of whom 525 (32%) had a high risk for PONV, received general anaesthesia. In this period, only 378 (23%) patients experienced PONV within 24 h after operation. This difference is statistically significant (P=0.01). CONCLUSION: Automated reminders can improve patient outcome by improving guideline adherence.

The relationship between sigmoidal intramucosal pH and intestinal arterial occlusion during aortic reconstructive surgery.

OBJECTIVES: To investigate the effects of perioperative occlusion of intestinal arteries on clinical outcome and changes in sigmoidal intramuscular pH (pHi). To determine the value of sigmoidal pHi measurement in predicting ischaemic colitis after aortic reconstructive surgery. DESIGN: Prospective, non-selective, open study. MATERIALS: Forty patients undergoing elective aortic infrarenal surgery were monitored with pHi. Pre- and postoperative digital venous subtraction angiography was combined with operative data to evaluate perioperative occlusion of intestinal arteries. RESULTS: All patients had a significant (p< 0.05) drop in pHi after aortic clamping which returned to baseline 2-4 h after declamping. None of the patients had clinical signs of ischaemic colitis postoperatively. All patients had angiographically proven, patent superior mesenteric arteries pre- and postoperatively. Patients were divided into three groups: patients with no changes in intestinal arteries (n=13), patients with perioperative occlusion of the inferior mesenteric artery (n=22) and patients with perioperative occlusion of the inferior mesenteric and one or both iliac arteries (n = 5); there were no significant differences in pHi values between the groups. CONCLUSIONS: Return of the sigmoidal pHi to baseline values within 6-12 h after declamping probably predicts a postoperative course without ischaemic colitis. Perioperative occlusion of the inferior mesenteric artery alone, or in combination with occlusion of one or both internal iliac arteries, does not cause ischaemic colitis in patients whose sigmoidal pHi rises after declamping.